Provider Demographics
NPI:1073293387
Name:KEOHO, JASMINE K (RBT)
Entity Type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:K
Last Name:KEOHO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 ALA MAKANI ST STE 200
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3571
Mailing Address - Country:US
Mailing Address - Phone:808-204-2893
Mailing Address - Fax:
Practice Address - Street 1:427 ALA MAKANI ST STE 200
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3571
Practice Address - Country:US
Practice Address - Phone:808-204-2893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-23-285655106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician